Paul Newton

While cancer outcomes in the UK have improved, inequalities remain with poorer and some ethnic minority populations experiencing lower survival rates. Research has addressed Gypsies’ and Travellers’ cancer-related beliefs, experiences and practices as part of wider studies but this is the first study in the UK to specifically focus on cancer. Findings suggest that health beliefs and practices are shaped by historical and contemporary social processes and the marginal position of Gypsies and Travellers in the UK society can result in a preference for seeking information and support from within the community. Starting from a health assets perspective, findings indicate that the structure of social relations in Gypsy and Traveller communities could be more widely utilized in health promotion programmes. Developing and extending techniques employed by Gypsy and Traveller Non-governmental Organisations such as community-based interventions and the use of lay health advisers, could be an effective method of health promotion by raising knowledge of cancer, engaging community members in preventative programmes and encouraging earlier access to services.

Objective We conducted a meta-analysis of controlled trials that used experimental models of acute pain and hyperalgesia to examine the analgesic effects of NMDA receptor (NMDAR) antagonists. Methods Six major databases were systematically searched (to March 2018) for studies using human evoked pain models to compare NMDAR antagonists with no-intervention controls. Pain outcome data were analyzed with random-effects meta-analysis. Results Searches identified 70 eligible trials (n = 1,069). Meta-analysis found that low-dose ketamine (p < 0.001) and a 1.2-point decrease (95% CI 0.88, 1.44, p < 0.001) in pain ratings from 4.6 to 3.4 on a 0–10 scale (a 26% reduction). Similar analgesia was observed for acute and hyperalgesic models and was constant across the dosing range (0.03–1.00 mg/kg). Moderate to high variability in effect size was observed and mild side effects (e.g., sedation, sensory disturbance) were common. No effects of dextromethorphan were found. Conclusions Findings provide robust evidence for analgesic and antihyperalgesic effects of ketamine, supporting its utility for acute and chronic pain management. However, pain relief was modest, suggesting ketamine may potentially be most useful when opioids are contraindicated, rapid analgesia is required, or for pain resistant to conventional medication.

Mortality rates remain high in patients with pelvic injuries despite improvements in trauma care in recent years. Pelvic injuries are associated with patients with a high Injury Severity Score (ISS); it can therefore be difficult to distinguish whether the pelvic injury was a primary causative factor of mortality. ‘Open book’ fractures carry a mortality rate as high as 50% and clinicians should therefore have a low threshold for suspecting a pelvic injury. Paramedics should follow the latest guidance found in the UK Ambulance Service Clinical Practice Guidelines ( Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2016 ; 2017 ). Additionally, log rolling and/or ‘springing’ the pelvis of a patient with a pelvic injury will cause pain, disrupt clots and distort a potential fracture. Furthermore, pelvic binders/splints can reduce the area into which a patient can haemorrhage, if they are placed correctly. Lastly, triage of these patients can be difficult and major trauma centres should be considered for definitive care.

Increased prevalence of dementia and poor oral health in older people is associated with more people living with dementia who experience oral pain and discomfort. However, little is known about how informal carers manage oral pain for people living with dementia in the community. This study aimed to explore informal carers’ experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Focus groups with informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Carers’ accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers’ accounts also highlighted issues in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural- and treatment- related barriers. Enablers included informal carers’ pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. The study concludes that carers want more partnership work with dental professionals, and clearer care pathways are required to meet the oral health needs of people living with dementia who experience oral pain.

Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on ‘patients’ non-attendance at retinal screening’, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5–13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not.

Background: Increasing immunization in the Gypsy, Roma and Traveller (G&T) community is a key priority for improving health outcomes in this community. This study aimed to explore G&T parents: (1) beliefs about childhood immunization; (2) beliefs about the risks of immunization and non‐immunization; (3) perceived obstacles to, and facilitators of, immunization and (4) views on increasing immunization levels.Method: A cross‐sectional, qualitative study was conducted comprising of five focus groups with 16 site‐dwelling G&T women with pre‐school aged children. Data were transcribed verbatim and analysed thematically.Results: Five main themes were identified: Lay understandings of causation and risk; Timing of immunization; Children being perceived as vulnerable; The fit between lifestyle and healthcare provision; The impact of living with a high burden of disease. Conclusion: Understanding of the risks and benefits of measles, mumps and rubella immunization did not differ significantly from the wider population or those promoted by the health service. The majority of barriers stemmed from living with the effects of long‐standing health inequalities, which posed further barriers to accessing immunization, and shaped beliefs about immunization. Factors facilitating uptake occurred where access to immunization services was made flexible, e.g. immunization on traveller sites.